Chair Massage Consent and Liability Form

Restore and Recover Therapy LLC

Ricardo Ruiz LMT NKT | Phone: 469-810-2945 | Email: ruizricardo@myabmp.com

Client Information

Name:

Phone:

Address:

City:

State:

Zip:

Email:

Consent for Chair Massage Therapy

I, the undersigned, voluntarily consent to receive chair massage therapy from Ricardo Ruiz, LMT NKT, at Restore and Recover Therapy LLC. I understand that chair massage is designed to promote relaxation, relieve muscle tension, and improve circulation.

Medical History

Please indicate if you have any of the following conditions (check all that apply):

Recent surgery Heart Conditions Blood Clots Skin Conditions Allergies Other (please specify):

Liability Waiver

I acknowledge that massage therapy is not a substitute for medical treatment or medications and that I should consult my physician or qualified health care provider for any health concerns. I understand that there are inherent risks associated with massage therapy, including, but not limited to, soreness, bruising, and aggravation of existing conditions. By signing below, I release and hold harmless Restore and Recover Therapy LLC, Ricardo Ruiz, and any staff associated with the treatment from any liability for injuries or damages that may occur as a result of receiving chair massage therapy.

Signature (draw with finger or mouse):

Please sign above. Signature is required.

Emergency Contact

Name:

Phone:

This form is for informational and consent purposes and does not replace medical advice.

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